Rheumatoid arthritis, NICE guideline

1.1 Referral, diagnosis and investigations

1.1.1 Referral for specialist treatment

1.1.1.1 Refer for specialist opinion any person with suspected persistent synovitis of undetermined cause. Refer urgently if any of the following apply:

• the small joints of the hands or feet are affected

• more than one joint is affected

• there has been a delay of 3 months or longer between onset of symptoms and seeking medical advice.

1.1.1.2 Do not avoid referring urgently any person with suspected persistent synovitis of undetermined cause whose blood tests show a normal acute-phase response or negative rheumatoid factor.

1.1.2 Investigations

1.1.2.1 Offer to carry out a blood test for rheumatoid factor in people with suspected RA who are found to have synovitis on clinical examination.

1.1.2.2 Consider measuring anti-cyclic citrullinated peptide (CCP) antibodies in people with suspected RA if:

• they are negative for rheumatoid factor, and

• there is a need to inform decision-making about starting combination therapy (see 1.4.1.1).

1.1.2.3 X-ray the hands and feet early in the course of the disease in people with persistent synovitis in these joints. 

Full Text

Gout Mx.

Gout is a common disease both in primary care and hospital practice. In UK general practices gout has an overall prevalence of 1.39%, with a male:female ratio of 3.6:1, but the disease remains rare in pre-menopausal women [1]. The incidence and prevalence of gout are both strongly age-related with a prevalence >7% in men, and >4% in women, over the age of 75 years [1].
Clinical manifestations of gout are associated with monosodium urate (MSU) crystal deposition in articular or peri-articular tissues and in the renal tract. It can present, and in some cases progress through four clinical stages if left untreated: asymptomatic hyperuricaemia, acute gout, intercritical or interval gout and chronic tophaceous gout. Classification criteria were proposed in 1977 and the presence of six or more of these criteria makes a diagnosis of gout highly likely [2] although the gold standard for diagnosis is the demonstration of urate crystals in synovial fluid or in a tophus by polarized light microscopy. ...Authorized only

Gout British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Gout, 2007 Rheumatology, Summary

Evaluating the Child with Purpura - August 1, 2001 - American Family Physician

Evaluating the Child with Purpura - August 1, 2001 - American Family Physician

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